To our knowledge, this was the largest study that aimed to determine the risk of animal exposure among travelers. In our study, the risk of being bitten was 1.11 per 100 travelers per month and the risk of being licked was 3.12 per 100 travelers per month. These incidences were close to the overall estimation of risk published in one recent review. In that review, based on all available evidences 
, it was estimated that 0.66% (0.02%–2.31%) of tourists will experience animal bite during one month stay 
It was not possible to compare our incidence rate directly with all previous studies since there were vast variations in term of the population studied, destination, definition of exposure and so on. However, several important points should be noted. Firstly, the highest incidence of animal exposure had been reported among travelers in Thailand in 1994 airport study. In that report, up to 1.3% of travelers had been bitten during an average stay of 17 days 
. Compared to the 1994 study, our study found an approximately two-fold decrease in the risk of being bitten (1.1% per month VS 2.2% per month). The lower incidence of animal bite may result from better awareness of rabies among travelers which could by imply from the vaccination rate i.e only 1.1% of travelers in the previous study had received rabies pre-exposure prophylaxis while up to 25% of travelers in our study had received rabies vaccine before their trips.
Apart from risk of animal bite, the endemicity of rabies in the destination is also the major factor that determines the real risk of exposure to rabies virus. Fortunately, data from Thailand showed that local situation of rabies was much improved when compared to the last few decades. For example, the number of human rabies in Thailand cases had decreased from 185 cases per year in 1990 to 78 cases per year in 1994 and to less than 20 cases annually since 2001 
. Moreover the percentage of FAT positive animal specimens among those examined for rabies were also decline i.e. from 41% in 1990 to 28% in 2000 and to 12% in 2004 
. Several factors were contributed to this success such as the control of stray dogs and cats, vaccination programs in animals, mass campaigns to raise public awareness and better and more accessible post-exposure treatment 
However it is important to note that, although the rabies situation in Thailand was much better and the risk of being bitten among travelers seemed to be lower than previous report, this risk was still high when compare to the other studies outside Southeast Asia 
. Partly, it may be due to the poor control of stray dogs and cats in many countries in Southeast Asia where more than 1 million people are estimated to be bitten annually 
. Not only local people, but travelers in these areas are inevitably at risk also. Given that rabies is an untreatable disease once the symptoms develop, travelers in rabies endemic areas need a good basic knowledge regarding rabies risk and prevention.
Unfortunately, our study found that, travelers' attitudes and knowledge related to rabies risk were far from ideal. As seen in several previous reports 
, many misconceptions and misunderstandings were found among our participants, such as, up to 59% were not aware that they might get rabies after being licked by an infected animal and 50% did not know that they needed a booster vaccination once they were bitten. These misconceptions were critical and might lead to serious consequences if they actually had been exposed to the rabies virus. In our study, we also confirmed that the travelers' practice after being exposed to animal was poor i.e. one fourth of the responding travelers who were bitten had not cleaned the wound and two third of responding travelers did not go to the hospital to get a rabies vaccination. These were serious and dangerous misunderstanding. Therefore, travelers to rabies endemic areas should receive proper advice regarding rabies before their trip. Travel clinic might be a good source of information as found in several studies 
. However, in our study, although travelers who had visited a travel clinic had higher mean knowledge scores than those who did not visit the clinic, some misconceptions were also found in comparable percentage between these two groups of travelers.
In this study, the length of stay in Southeast Asia was significantly related to higher rate of animal exposure. Age, gender, and travelers' knowledge, had no significant relationship to rate of animal exposure. Apart from length of stay, multivariate analysis indicated that the nationality of a traveler was related to the risk of animal exposure. Travelers from East Asia had a 2.8-fold higher risk than travelers from Western/Central Europe, while travelers from South Asia had a significantly lower risk. These differences might imply that travelers from different cultures might have different attitudes and different risk behaviors that can be related to a higher or lower risk of animal exposure. For example, travelers from South Asia where rabies was highly endemic might have higher rabies awareness than travelers from Europe, so they were less likely to risk encounter with an animal.
Through the analysis, we also found that the reason for travel was not related to the risk of animal exposure. Hence the magnitude of risk among tourists, businessmen and students in Southeast Asia could be considered the same. This finding might challenge the general belief that the activities of travelers play some role in terms of risk. Although it is logical to assume that, so far there was no available evidence to support this belief, at least in Southeast Asia. This may be in part be due to the fact that stray dogs and cats in Southeast Asia are not restricted to only certain areas, but rather can wander freely around in urban and rural areas. This might explain why, when compared to our recent study done in backpackers in Bangkok 
, the risk of being bitten in the backpacker group was even lower than that in general travelers in this study (0.69 per 100 backpackers per month VS 1.11 per 100 travelers per month). Similar findings were also reported in a study conducted in Nepal, where trekking did not increase the risk of animal exposure 
Although many authorities recommend pre-exposure rabies vaccination in high risk travelers 
, there was no consensus what defines “high risk”. In our study, twenty-seven percent of our participants received rabies vaccine before their trips. Several factors including male sex, younger age, travel for tourism and, surprisingly, a shorter length of stay were found to be correlated to higher vaccination rates. We also found that travelers from countries with a cost index <20 were more likely to receive the vaccine. As in many studies, this was confirmed that cost of the vaccine was an important factor that travelers consider before receiving the pre-exposure vaccines 
Our study had some limitations. Although we surveyed more than 7,000 departing travelers from Suvarnabhumi International Airport, which is the main airport hub in Southeast Asia, data from a single airport is not ideal for representing the whole of Southeast Asia. Our data should strongly represent travelers in Thailand and its neighboring countries such as Lao PDR, Cambodia and Vietnam, because most of them use Suvarnabhumi International Airport as a travel hub. But our data may underrepresent people who travel mainly in Indonesia, Singapore and the Philippines, since they may use other airports. Ideally, a multi-airport study could provide more comprehensive data.
Second, the language barrier may have led to selection bias in our study. In this study, apart from English, we translated our questionnaire to 3 different languages i.e. Chinese, Japanese, and Korean. However, the questionnaire were not translated into Arabic, Hindi, Spanish, or any African languages. So those travelers from the Middle East, India, Africa and Latin America, who did not understand English, had to be excluded from the study. It is possible that travelers from those areas who understood English and those who did not may have different risk characteristics.
Third, children, who represent a recognized at-risk population for animal bites and rabies, 
were not included in our survey, which may have biased the results.
We could conclude that travelers in Southeast Asia, regardless of their reasons for travel, had a significant risk of being bitten or licked by animals while traveling. A longer duration of stay was associated with a higher risk. However, it must be pointed out that 53.8% of travelers with exposure to potential rabies infected animals were actually exposed while traveling for less than 3 weeks. Many were inadequately informed and lacked a basic knowledge of this life-threatening risk. Rabies prevention advice should be included in every pre-travel visit.